“We try our best”: a qualitative study of care staff’s perspectives on oral health care for persons with disabilities

Persons with disabilities generally have poorer oral health than persons without disabilities, which negatively affects their quality of life. As caregivers play an important role, this study investigated how oral health care is organised and performed by care staff in residential care settings, and examined the barriers and enablers they experience. A qualitative study was conducted within the social constructionist research paradigm. Eight semi-structured focus group interviews and three individual interviews were carried out between November 2019 and January 2023 with a total of 43 female care staff members from 16 residential care organisations. Data analysis was guided by reflexive thematic analysis. Four major themes were identified. Care staff were aware of clients’ oral health needs but faced difficulties in managing them. They faced challenges in both providing daily oral health care and planning professional oral health care. Ineffective coping strategies such as lowering standards, distancing oral health care from general care, and externalising responsibility were reported (Theme 1). Furthermore, oral health was perceived as a source of tension within the organisation, including conflicts with clients or their network, within and between staff teams, and across different organisational levels (Theme 2). Care staff mentioned setting-related challenges, including the diversity of clients and variations in workflows and organisational structures within and between organisations (Theme 3). Despite these challenges, several enablers were identified, including the availability of clear guidelines, tailored training, and collaboration with external partners (Theme 4). Care staff in residential settings for persons with disabilities face persistent challenges in providing oral health care. However, the enablers identified in this study offer valuable guidance for researchers and practitioners seeking to improve oral health in this setting.